application for admission

INTERNATIONAL STUDENTS Page 1 of 2

Part 1: Personal Data

Date of Birth: Gender: Tel: 519-452-4150
Fax: 519-659-9393
Year Month Day Male Female E-mail: intapp@fanshawec.ca

Last Name or Family Name:

First and Middle Name:

Mailing Address
Street Address:: Apt #:

City: Province/State (if applicable) Country:

Postal Code: Home Telephone Number: Fax Number:

E-mail Address:

Country of Birth: First Language: Citizenship:

Part 2: Programs (please specify the program(s) to which you are applying)
English Studies
ESL Program Number of months for ESL Program ESL Start Date Requested
Year Month Day
Diploma, Certificate or Degree Program

(Specify program by name)

Program Start Date Requested September or January* *Please refer to the Web site
Year www.fanshawec.ca or the Program
Guide since not all programs start
March* May* in January, March or May.
Part 3: Accommodation
You have several options for accommodations while studying at Fanshawe. We offer Homestay and student dormitories,
or you may rent off-campus. For more details visit our Web site at www.fanshawec.ca/international/accommodation.asp

PLEASE COMPLETE OTHER SIDE

Fanshawe College Application for Admission Page 2 of 2

Last Name or Family Name: First Name:

Part 4: English Testing * Please ensure that we have verification of your test results for TOEFL
or IELTS if applicable. TOEFL and IELTS results must be within the past
Give TOEFL or IELTS Score:* Date Completed 24 months. TOEFL scores must be sent directly by the TOEFL testing
centre to Fanshawe College (Institution #9120). If you are submitting an
IELTS score, Fanshawe College must see your original certificate before
(If applicable) Year Month you will be allowed to start your college program.

Part 5: Agency Information (If applicable)

Agent Name: (if applicable) Company Name:

City: Country:

Business Telephone Number: Fax Number:

E-mail Address: Web Page:

Part 6: Payment Information

I will be paying the $100.00 non-refundable Application Deposit in Canadian Funds payable to Fanshawe College by:

Bank (Wire) Transfer Credit Card

Transfer to:
Type of Credit Card: Visa Master Card
Bank Name : The Bank of Nova Scotia Note : Your Bank Transfer
must be in Canadian funds
Scotia Plaza 40 King St W 2nd Mezz Name on Credit Card: __________________________________
and it must include all bank
Toronto, Ontario, Canada M5W 5P6 charges in addition to the
amount you owe to Credit Card Number
SWIFT: NOSCCATT
Fanshawe College.
Bank Number: 002
Please specify your name and
Transit Number: 67876
your Fanshawe College
Account Number: 205520026417 Student Number, if Credit Card Expiry Month Year
Payable to (Beneficiary): applicable. Fanshawe does
Fanshawe College, London, Ontario not accept Bank Drafts. Signature of Credit Card Holder: __________________________

Part 7: Declaration/Release of Information

I declare that the above application information is true and complete. I understand that any false or incomplete information submitted in support of my application
may invalidate my application and result in withdrawal by Fanshawe College of a place which may be offered and that this withdrawal may also happen at any time
during my enrollment.
I hereby authorize Fanshawe College to obtain any details regarding my academic record at the institutions listed in this document in order to evaluate my application.
I also authorize Fanshawe College to release application information, Letter of Admission, transcripts, progress and attendance records, as may be requested by my
parents, agents, sponsor or other educational institutions.
Freedom of Information and Protection of Privacy Act: The information on this form is collected under the legal authority of the Ministry of Education and Training,
R.S.O. 1990, cM19:R.R.O. 1980, Reg. 770. It is used for administrative and statistical purposes. For further information, please contact the Registrar, Fanshawe College,
P.O. Box 7005, London, ON, N5Y 5R6, telephone (519) 452-4277.

SIGNATURE: __________________________________________________________________ DATE: ___________________________________

(APPLICANT)

SIGNATURE: __________________________________________________________________ DATE: ___________________________________

(PARENT/GUARDIAN/CANADIAN CONTACT PERSON IF APPLICANT IS UNDER 18 YEARS OF AGE)